Wiki Chemotherpy and same day lab denials

[kbassano@cmcvtx.org]

Has anyone encountered labs being denied as inclusive when done same day as chemotherapy infusion charges are billed? The scenario is: Labs are drawn in the office and sent to the hospital for processing and billing by the hospital The patient also has chemotherapy infusion at the same hospital on the same day. The labs are being denied as inclusive. Are these appealable? If not what is the CMS rule that addresses this? If not appealable, what alternative solutions are you employing?

Thank you.

 

[thomas7331]

Are you referring to the hospital's UB facility claim that has the lab charges on it? Under OPPS facility reimbursement, clinical labs are packaged to almost all other outpatient services - you will not see separate payment for lab charges on outpatient hospital claims that include other services on the same date. This is not a denial, it is just the way the CMS reimbursement methodology works. The reimbursement for any labs is calculated into the APC rates that are set for those other outpatient services, so the hospital is indeed getting paid for those, it's just not a separate line item fee for the lab code itself.